Adverse Effects Of Smoking Research Articles

To assess the preparedness of primary care physicians in terms of their knowledge, attitude, beliefs, and confidence regarding smoking cessation in Gilgit

ABSTRACT Background: Tobacco smoking poses a great threat to the healthcare system both in developed and developing countries due to its health hazard. Healthcare professionals and in particular physicians can play an effective role in encouraging people to quit smoking which will ultimately improve the overall health of their patients and hence prolong their lives Subjects and Methods: Data were collected from physicians from public and private hospitals that included Aga khan Health Services in Gilgit, Ghizer, and Hunza, District health quarter Hospitals in Gilgit, Hunza, and Ghizer, Sehat foundation between 1 December, 2021, and 30 May, 2022. A precoded questionnaire was filled which assessed the knowledge, attitude, practices, beliefs, and confidence of physicians in smoking cessation. Results: The mean age of physicians was 35.4 ± 9.11 years, of which 64.7% (n = 66) were males and 10.8% (n = 11) were current smokers. 23.5% (n = 24) of physicians had received formal training on smoking cessation (P value 0.002). 55.5% (n = 57) were unsure that Bupropion helps in quitting smoking and only 23.5% (n = 24) reported that they are very well prepared for counselling, whereas 42.2% (n = 44) were unsure how to assess smoker’s different stages of readiness to quit. Conclusion: We concluded that physicians of Gilgit Baltistan have sound knowledge about the adverse effects of smoking, but they are not confident in prescribing medication due to unaware of different methods of treatment available for smoking cessation.

Impact of cigarette smoking on the outcomes of ST-elevation myocardial infarction after primary percutaneous coronary intervention in metropolitan Tehran

Objective: Although the adverse effects of smoking are well-established, evidence shows a longer survival rate following an acute myocardial infarction (MI) among smokers or the so-called “smoker's paradox”. This study aimed to determine the impact of smoking on the one-year clinical outcomes of ST-elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PPCI) in a large registry of the Iranian population. Methods: A total of 3087 patients diagnosed with acute STEMI who underwent PPCI between 2013 and 2018 were enrolled in the study. Patients' smoking status was determined based on self-reported history and categorized into two groups: current smokers and non-smokers. Clinical and angiographic data were collected from the Tehran Heart Center (THC) registry. The primary outcome was one-year of major adverse cardiac and cerebrovascular events (MACCE). The effect of smoking on MACCE was evaluated using a Cox model. Results: From the study population, 1967 (63.7%) were non-smokers, and 1120 (36.3%) were current smokers. Non-smokers had higher rates of prior CABG (5.3%) as well as a higher history of co-morbidities, including a history of diabetes mellitus (46.0%), hypertension (52.7%) and hyperlipidemia (55.4%) than smokers (2.3%, 30.4%, 35.7%, and 49.8% respectively). Smokers had a higher reference vessel diameter than non-smokers (P=0.005). The unadjusted hazard ratios (HRs) for MACCE within one year were significantly lower in smokers than non-smokers (0.73, 95% CI: [0.58,0.92]; P=0.009); however, after adjustment for confounders, the HRs for MACCE in smokers were similar to non-smokers (HR: 1.00, 95% CI: [0.73,1.38]). Conclusion: The study found that smoking had no significant impact on the one-year clinical outcomes of STEMI patients after PPCI in the Iranian population. This study is the first of its kind to assess the effect of smoking on STEMI patients in Iran and highlights the need for further research in this area.

Adverse effect of smoking on surgical site infection following ankle and calcaneal fracture fixation: a meta-analysis.

Studies have reported conflicting findings on the relationship between smoking and surgical site infection (SSI) post fixation for ankle and calcaneal fractures. This meta-analysis explored the effect of smoking on SSI incidence following open reduction and internal fixation (ORIF) of these fractures. Full-text studies on smoking's influence on post-ORIF SSI rates for closed ankle and calcaneal fractures were sourced from the PubMed, Embase, and Cochrane databases, with no consideration given to language or publication date. Study quality was appraised using the Newcastle-Ottawa Scale. Odds ratios (OR) and the corresponding 95% CIs were determined using random-effects models. This meta-analysis adhered to the PRISMA guidelines and was registered with PROSPERO (CRD42023429372). The analysis incorporated data from 16 cohort and case-control studies, totaling 41 944 subjects, 9984 of whom were smokers, with 956 SSI cases. Results indicated smokers faced a higher SSI risk (OR: 1.62; 95% CI: 1.32-1.97, P < 0.0001) post ORIF, with low heterogeneity (I 2 = 26%). Smoking was identified as a significant deep SSI risk factor (OR: 2.09; 95% CI: 1.42-3.09; P = 0.0002; I 2 = 31%). However, the subgroup analysis revealed no association between smoking and superficial SSI (OR: 1.05; 95% CI: 0.82-1.33; P = 0.70; I 2 = 0%). Smoking is associated with increased SSI risk after ORIF for closed ankle and calcaneus fractures. Although no clear link was found between superficial SSI and smoking, the data underscore the negative influence of smoking on deep SSI incidence.

Determining the Short-term Effects of Smoking Cessation Using Nicotine Gum on Oral Health-Related Quality of Life: A Pilot Study.

Nowadays, the adverse effects of smoking on general, oral, and dental health are reported time and again worldwide. However, evidence to quantify the effects of tobacco smoking and smoking cessation on health-related quality of life (HRQoL) and oral health-related quality of life (OHQoL) is inadequate. Accordingly, this study aimed to assess the effects of nicotine gum on HRQoL and OHQoL of cigarette smokers. This pilot study was conducted on 40 smokers, half of whom received nicotine gum. HRQoL and OHQoL were measured twice at the beginning of the study and after three months using standard versions of Short Form Health Survey (SF-12) and Oral Health Impact Profile (OHIP-5) questionnaires. T-test, Fischer's exact test, and Pearson's correlation coefficient were used to compare the participants' scores on the questionnaires. The mean age of the participants was 43.39±12.32 years. Using nicotine gum significantly increased the scores of general health (P=0.046) and physical functioning (P=0.021) domains of HRQoL in comparison with the cigarette smoking group. Moreover, using nicotine gum significantly increased the scores of the two questions about the reduced sense of taste (P<0.001) and difficulty doing usual jobs (P=0.071). Using nicotine gum was associated with the improvement of HRQoL and OHQoL to some extent. To better understand the relationship between smoking cessation and improved OHQoL, it is necessary to conduct further studies in this field.

Bridging the Gap Between Observational Studies and Randomized Clinical Trials

In his landmark 1985 article in The New England Journal of Medicine, “Statistical concepts fundamental to investigations” ( 1 Moses L.E. Statistical concepts fundamental to investigations. N Engl J Med. 1985; 312: 890-897 Crossref PubMed Scopus (44) Google Scholar ), Lincoln Moses, the founder of the Division of Biostatistics at Stanford University, compares randomized controlled trials and observational studies in their ability to influence health policy. To illustrate, he discusses 2 groups of experiments: the polio vaccine randomized clinical trial (RCT) and a series of 7 large-scale observational studies exploring the association between smoking and lung cancer, all published in 1954. He notes that in the Surgeon General’s 1964 report Smoking and Health, a consensus was finally reached that smoking elevated the risk of lung cancer by 10-fold. He explains that it took 10 years to reach this conclusion because “For each study indicating an adverse effect of smoking it was possible to suggest some possible biases that were not controlled, thus casting doubt on the indicated effect.” By contrast, the randomized, double-blind, placebo-controlled polio vaccine trial definitively demonstrated a 2.5-fold risk reduction, much smaller than the increased risk associated with smoking and lung cancer. Nevertheless, the results of the polio vaccine trial were accepted and put into practice within a year whereas it took at least a decade for a consensus to be reached regarding smoking and lung cancer. SEE CORRESPONDING ARTICLE ON PAGE 1127 SEE CORRESPONDING ARTICLE ON PAGE 1127 Emulating a Target Trial of Dynamic Treatment Strategies for Major Depressive Disorder Using Data From the STAR∗D Randomized TrialBiological PsychiatryVol. 93Issue 12PreviewClinical guidelines recommend adding a second drug for patients with major depressive disorder who have a partial response and switching antidepressants for those who show no response or intolerance. This guidelines-based strategy was compared with other strategies for the management of unresponsive depression. Full-Text PDF

The Impact of Smoking History on Outcomes and Morbidity After Robotic Hepatectomy.

The detrimental effects that smoking has on patient health and postoperative morbidity are well documented. However, literature on the impact that smoking history has on robotic surgery, specifically robotic hepatectomy, is scarce. This study was undertaken to determine whether smoking history impacts the postoperative course of patients undergoing robotic hepatectomy. We prospectively followed 353 patients that underwent robotic hepatectomy. 125 patients had an apposite history of smoking (ie, smokers) and 228 patients were classified as non-smokers. Data were presented as median (mean ± SD). Patients were then propensity-score matched based on patient and tumor characteristics. Prior to the matching, the MELD score and cirrhosis status in patients who smoke were found to be significantly higher when compared to those who do not (mean MELD score 9 vs 8 and cirrhosis in 25% vs 13% of patients, respectively). Both smokers and non-smokers have similar BMIs, number of previous abdominal operations, ASA physical status classifications, and Child-Pugh scores. Six percent smokers vs one percent non-smokers experienced pulmonary complications (pneumonia, pneumothorax, and COPD exacerbation) (P = .02). No differences were found for postoperative complications of Clavien-Dindo score ≥ III, 30-day mortality, or 30-day readmissions. After the matching, no differences were found between the smokers and the non-smokers. After a propensity-score match analysis, smoking did not appear to negatively affect the intra- and postoperative outcomes after robotic liver resections. We believe that the robotic approach as the most modern minimally invasive technique in liver resection may have the potential to mitigate the known adverse effects of smoking.

Smoker pseudo-paradox in ST-segment elevation myocardial infarction patients

Cigarette smoking is a preventable cause of cardiovascular morbidity and mortality. Despite the adverse effects of smoking, some studies have reported the term "smoker's paradox', meaning better outcomes in smokers following acute myocardial infarction. The aim of the present study was to evaluate the relationship between smoking status and one-year mortality in patients with ST-segment elevation myocardial infarction (STEMI). This was a registry-based cohort study of STEMI patients from Imam-Ali hospital, Kermanshah, Iran. Consecutive STEMI patients (July 2016-October 2018) were stratified by smoking status and followed for one year. Cox proportional models were used to estimate crude, age-adjusted, and full-adjusted hazard ratios with 95% confidence intervals (HR, 95%CI). Of 1975 patients (mean age 60.1 years, 76.6% male) included in the study, 48.1% (n=951) were smokers (mean age 57.7 years, 94.7% male). Crude and age-adjusted HR (95% CI) for the associations of smoking and mortality were 0.67 (0.50-0.92) and 0.89 (0.65-1.22), respectively. After adjusting for age, sex, hypertension, diabetes, body-mass index, anterior wall myocardial infarction, creatine kinase-MB, glomerular filtration rate, left ventricular ejection fraction, low-density lipoprotein cholesterol, and hemoglobin, smoking was associated with increased risk of mortality: HR (95% CI: 1.56 (1.04-2.35). In our study, smoking was associated with an increased risk of mortality. Although the smokers had a better outcome, this would be reversed after controlling for age and the other STEMI associated factors.

Changes in biomarkers of endothelial function, oxidative stress, inflammation and lipids after smoking cessation: A cohort study.

Tobacco use is known to be involved in the development of cardiovascular diseases, which leads to premature mortality. Endothelial dysfunction, the first step in this process, was shown induced by smoking. It is reported that quitting smoking could reduce the risk of diseases, but the implied mechanisms are still unclear. This study aimed to evaluate the biological markers of endothelial function in smokers when actively smoking and after cessation. Quantification of several biomarkers reflecting inflammation, endothelium activation, oxidative stress, and lipids was performed in 65 smokers when actively smoking and after cessation (median abstinence duration of 70 days). A possible decrease of inflammation was observed through the concentration reduction of a proinflammatory cytokine (interleukine-6) on quitting. A decrease of endothelium activation was visible by the reduced level of the soluble intercellular adhesion molecule. Two antioxidants, uric acid and vitamin C, were found at higher concentration than before the cessation, potentially reflecting the decrease of oxidative stress on quitting. Lipid profile was improved post-quit since HDL level was increased and LDL level was decreased. All these effects were visible at short term with abstinence duration less than 70 days. No sex-specific difference was observed and no additional changes were observed for longer abstinence duration. These observations suggest that some adverse effects of smoking on endothelial function could be reversible on quitting smoking. It could encourage smokers to enter a cessation program to reduce the risk for cardiovascular diseases development.

Maternal smoking during pregnancy negatively affects brain volumes proportional to intracranial volume in adolescents born very preterm.

Maternal smoking during pregnancy has been shown to associate with smaller frontal lobe and cerebellar volumes in brain magnetic resonance imaging (MRI) at term age in very preterm infants. The aim of this study was to examine the effect of maternal smoking during pregnancy on volumetric brain MRI findings at 13 years. We hypothesized that adverse effects of smoking during pregnancy on brain volumes are still seen during adolescence. Included adolescents were born very preterm (gestational age < 32 weeks and/or birth weight ≤ 1,500 g) between April 2004 and December 2006 at the Turku University Hospital, Finland. Information on maternal smoking status (yes or no) during pregnancy was collected from medical records and maternal questionnaires before discharge. Adolescents underwent volumetric brain MRI at 13 years of age. Image post-processing was performed with FreeSurfer. Regional volumes, cortical thickness, surface area, and curvature were computed from 33 cortical regions of interest (ROIs). Additionally, volumes were calculated for 18 subcortical regions, as well as for white matter, gray matter, and intracranial volume. We normalized quantified absolute volumes for head size by dividing volumes with corresponding intracranial volumes. false discovery rate (FDR) correction for multiple comparisons across regions was used. A total of 9/44 (21%) adolescents had been exposed to maternal smoking during pregnancy. No statistically significant differences in absolute volumes were observed between the groups (p > 0.05). Regarding volumes proportional to intracranial volume, the adolescents in the exposed group exhibited smaller gray matter volumes in the inferotemporal (FDR corrected p = 0.022) and parahippocampal (p = 0.018) regions compared to the unexposed group. The surface area in the exposed group was also smaller in the parahippocampal (p = 0.046) and postcentral (p = 0.046) regions compared to the unexposed group. No statistically significant differences after correction for multiple comparisons were found for either curvature or cortical thickness between the groups. Maternal smoking exposure during pregnancy may have long-term effects on brain volumes up to 13 years in adolescents born very preterm. Our findings emphasize the importance of smoking-free pregnancy.

Smoking Cessation after Cancer Diagnosis and Enhanced Therapy Response: Mechanisms and Significance

The adverse effects of smoking on human health have been recognized for several decades, especially in the context of cancer. The ability of tobacco smoke components, including tobacco-specific carcinogens and additive compounds such as nicotine, to initiate or promote tumor growth have been described in hundreds of studies. These investigations have revealed the tumor-promoting activities of nicotine and other tobacco smoke components and have also recognized the ability of these agents to suppress the efficacy of cancer therapy; it is now clear that smoking can reduce the efficacy of most of the widely used therapeutic modalities, including immunotherapy, radiation therapy, and chemotherapy. Several studies examined if continued smoking after cancer diagnosis affected therapy response; it was found that while never smokers or non-smokers had the best response to therapy, those who quit smoking at the time of diagnosis had higher overall survival and reduced side-effects than those who continued to smoke. These studies also revealed the multiple mechanisms via which smoking enhances the growth and survival of tumors while suppressing therapy-induced cell death. In conclusion, smoking cessation during the course of cancer therapy markedly increases the chances of survival and the quality of life.

The effect of smoking in the polymorph nuclear neutrophils’ functions in patients with gingivitis

Smoking is a habit that is widespread in today’s world as its primary constituent called Nicotine makes it very addictive for the users. Smoking is an important cause of diseases related to gums. If not quitted, it may lead to progressive adverse conditions in the oral cavity like gingivitis, periodontitis and so on. This is because the functions of neutrophils are significantly affected by smoking. As a result of the suppression of the activity of the neutrophils, the overall oral health of the individuals also become compromised. This article aims to describe the pattern and clearly delineate the difference in the condition of gingiva between smokers and nonsmokers by explaining the changes brought about by smoking on the polymorphonuclear neutrophils. Three groups of people were selected for this study. The groups were matched by age and gingival condition. Two groups consisted of people with the habit of smoking, and they were further categorized into mild smokers and heavy smokers depending on the number of cigarettes smoked per day. The third group consisted of people with no habit of smoking. This group was the control group in the study. Blood samples were taken and Polymorphonuclear neutrophils were isolated. The functions of PMNs like chemotaxis and phagocytosis were studies under different methods. The mean value for the all the three groups under clinical parameters like plaque index, gingival index, and the functions of neutrophils like chemotaxis and phagocytosis are obtained and after elucidating the results, it is found that smoking impairs the overall oral hygiene and the functions of neutrophils against gingival infections.It is proven that there is debasing alteration in the functions of neutrophils which could have led to the localized destruction. Hence it suggests that smoking impairs the functions of neutrophils against gingival infections. And there may be a higher possibility of this condition to progress into the next stage called periodontitis. Hence it is advisable to quit the habit as and when it is possible, and it is the role of dentists to identify such conditions and educate the patients on the adverse effects of smoking.

Association of Awareness in Medical and Dental Students regarding Adverse Effects of Smoking on Periodontal Health

Aim: To study the association of awareness in medical and dental students regarding the adverse effects of smoking on periodontal health. Methodology: A data was gathered from 290 college students through a simple random sampling technique by using a Cross-sectional study. The questionnaire was split into two sections where data on demographics and questions on knowledge of the effect of smoking on periodontal health were gathered from the participants. The study was started after getting institutional ethical approval. All participants verbally consented, and confidentiality was maintained. A p-value of 0.05 was regarded as significant, with a confidence interval of 95%. The Chi-square test with SPSS version 26 was used to examine the statistical significance of various associations. Results: A total of 290 students completed the questionnaire and out of which 140(48.3%) were BDS students while 150 (51.7%) were MBBS students. The results obtained on awareness regarding the effects of smoking on periodontal health showed that gum diseases (0.003), halitosis (0.010), delayed wound healing (0.009), altered taste sensation (0.001), Oral cancer(0.013), mouth ulcers (0.036) were significantly associated with the use of smoking. The results emphasized to conduct anti-smoking awareness in students by conducting oral health education programs to persuade individuals to give up the smoking habit as many of the students were not willing to quit smoking despite knowing the harmful effects of smoking. Therefore, use of tobacco must be banned and it should be addressed at primary preventive level with a focus on quitting the tobacco which will further reduce the disease burden on the healthcare system related with smoking. Conclusion: There was a significant association between awareness regarding the effects of smoking on periodontal health which showed that gum diseases, halitosis, delayed wound healing, altered taste sensation, oral cancer, and mouth ulcers are related to smoking. Keywords: Oral Cancer, Gum disease, Mouth ulcer, Awareness, Halitosis, Tobacco, Smoking, Periodontal health.

Impact of smoking on oral health

Introduction: Smoking kills more than 8 million people each year worldwide. The rate of morbidity from illnesses linked to smoking is increasing steadily. The adverse effects of smoking on oral health are well documented. The ability of medical and dental students to assist people in quitting smoking is crucial. Objectives: The aim of this study was to evaluate smoking habits, the level of knowledge and attitudes of medical and dental students towards smoking, as well as the role of dental professionals in prevention of smoking. Methodology: A cross-sectional study, including 150 medical and dental students from the Khyber Medical University, housing officers and dentists from the Hayatabad Medical Complex and Peshawar Dental College, was conducted and data was collected by a pre-designed questionnaire. The questionnaire asked about the patient's smoking and quitting habits, their medical and dentists' experiences with smoking cessation and their readiness to follow dentists' recommendations for quitting. Results: Most of the participants were medical students (81/150) and males (99/150). Majority of them were from 18-30 years old.

Attitude and Practice Toward Use of Cigarettes and Electronic Cigarettes Among Pregnant Women: A Questionnaire-Based Survey.

This study aimed to evaluate attitude and practice toward use of regular tobacco cigarettes and electronic cigarettes among pregnant women. A total of 1123 pregnant women participated on a voluntary basis in this questionnaire survey. Maternal characteristics, cigarette consumption parameters, and personal opinions regarding the adverse effects of smoking during pregnancy were evaluated. Active smokers composed 12.4% (9.4%: regular tobacco cigarettes, 3.0%: electronic cigarettes) of the study population. Smoking during the current pregnancy, particularly via regular tobacco cigarettes, was more likely for women with smoking during previous pregnancies (56.0% vs. 7.8%, P < .001), previous history of low birth weight infant delivery (16.1% vs. 8.6%, P = .013), premature delivery (16.7% vs. 7.0%, P < .001), and stillbirth (22.8% vs. 11.7%, P = .002). The presence versus absence of smoking during pregnancy was associated with a lower likelihood of being a housewife (70.5% vs. 80.5%, P = .010) and a higher likelihood of having an actively smoking mother (25.9% vs. 11.2%, P < .001) or partner (65.7% vs. 46.9%, P < .001). Regular tobacco cigarette users considered electronic cigarettes to have a higher risk of adverse impacts (11.1% vs. 2.9%, P = .012), while electronic cigarette users considered regular cigarettes to have a higher risk of nicotine exposure (55.9% vs. 13.0%, P < .001). Our findings indicate being employed, having an actively smoking mother or partner, as well as smoking in previous pregnancies, to be the risk factors for increased likelihood of smoking during pregnancy.

Income-related inequalities in the association of smoking with periodontitis: a cross-sectional analysis in Tokyo Metropolitan Districts.

Socio-economic status (SES) and smoking are risk factors for periodontitis; however, their interaction has not been determined. We investigated the effect of modification of SES and smoking with periodontal conditions. Data on the social background, smoking status, and dental examination of 1033 individuals residing in the Tokyo Metropolitan District were analyzed. The outcomes were the number of remaining teeth and the proportion of teeth with probing pocket depth (PPD) ≥ 4mm and ≥ 6mm. Multilevel linear and Poisson regression analyses were performed after adjusting for possible confounding factors, including SES, assessed by the average income of the residential area. The mean number of remaining teeth was 24.6 ± 4.8, and the proportion of teeth with PPD ≥ 4mm and ≥ 6mm was 31.2 ± 28.5% and 12.2 ± 18.1%, respectively. After adjusting for confounding factors, the lowest-income population had significantly lesser teeth (coefficient: - 0.46, 95% CI - 0.89, 0.02, p = 0.039) and a higher proportion of teeth with PPD ≥ 4mm than the highest-income population (ratio of means: 1.22, 95% CI 1.03-1.44, p = 0.013). Significant interactions were observed; income inequalities in periodontitis were significant only among current smokers. Inequality in socio-economic status is associated with oral health inequalities. The adverse effects of smoking on periodontitis might be greater in the low-income population. The low-income population, especially current smokers, had significantly more compromised oral health than the high-income population. In addition to the emphasis on smoking cessation, the promotion of universal health coverage for dental care is necessary to reduce oral health inequalities.

Immunological Insights into Cigarette Smoking-Induced Cardiovascular Disease Risk.

Smoking is one of the most prominent addictions of the modern world, and one of the leading preventable causes of death worldwide. Although the number of tobacco smokers is believed to be at a historic low, electronic cigarette use has been on a dramatic rise over the past decades. Used as a replacement for cigarette smoking, electronic cigarettes were thought to reduce the negative effects of burning tobacco. Nonetheless, the delivery of nicotine by electronic cigarettes, the most prominent component of cigarette smoke (CS) is still delivering the same negative outcomes, albeit to a lesser extent than CS. Smoking has been shown to affect both the structural and functional aspects of major organs, including the lungs and vasculature. Although the deleterious effects of smoking on these organs individually is well-known, it is likely that the adverse effects of smoking on these organs will have long-lasting effects on the cardiovascular system. In addition, smoking has been shown to play an independent role in the homeostasis of the immune system, leading to major sequela. Both the adaptive and the innate immune system have been explored regarding CS and have been demonstrated to be altered in a way that promotes inflammatory signals, leading to an increase in autoimmune diseases, inflammatory diseases, and cancer. Although the mechanism of action of CS has not been fully understood, disease pathways have been explored in both branches of the immune system. The pathophysiologically altered immune system during smoking and its correlation with cardiovascular diseases is not fully understood. Here we highlight some of the important pathological mechanisms that involve cigarette smoking and its many components on cardiovascular disease and the immune systems in order to have a better understanding of the mechanisms at play.

Protective effects of caffeic acid phenethyl ester (CAPE) and thymoquinone against cigarette smoke in experimental bone fracture healing.

This study investigated the protective characteristics of caffeic acid phenethyl ester (CAPE) and thymoquinone (TMQ) against the effects of cigarette smoke in recovery from bone fractures. Sixty Wistar albino rats were divided into six groups (n=10). The rats' femur bones were fractured and then fixed with microplates and microscrews. In the CAPE group, CAPE was given by intraperitoneal injection for 30 days at a dose of 10μmol/kg once a day. In the TMQ group, TMQ was given orogastrically for 30 days at a dose of 10mg/kg once a day. In the cigarette groups, CAPE was given by intraperitoneal injection for 30 days at a dose of 10μmol/kg once a day (CAPE-CG), TMQ was given orogastrically for 30 days at a dose of 10mg/kg once a day (TMQ-CG), and controls were exposed to cigarette smoke three times a day for 8min each time for 30 days. The controls received no postoperative treatment. The rats were sacrificed on the 30th day following surgery. According to the histopathological and immunohistochemical results, cigarette smoke had a negative impact on bone healing. TMQ and CAPE increased bone formation and reduced bone destruction. Therefore, TMQ and CAPE were found to be partially protective against the adverse effects of smoking on bone tissue.

A practical guide for perioperative smoking cessation.

The perioperative management of patients who are smokers presents anesthesiologists with various challenges related to respiratory, circulatory, and other clinical problems. Regarding 30-day postoperative outcomes, smokers have higher risks of mortality and complications than non-smokers, including death, pneumonia, unplanned tracheal intubation, mechanical ventilation, cardiac arrest, myocardial infarction, and stroke. Given the benefits of smoking cessation and the adverse effects of smoking on perioperative patient management, patients should quit smoking long before surgery. However, anesthesiologists cannot address these issues alone. The Japanese Society of Anesthesiologists established guidelines in 2015 (published in a medical journal in 2017) to enlighten surgical staff members and patients regarding perioperative tobacco cessation. The primary objective of perioperative smoking cessation is to reduce the risks of adverse cardiovascular and respiratory events, wound infection, and other perioperative complications. Perioperative preparations constitute a powerful teachable moment, a "golden opportunity" for smoking cessation to achieve improved primary disease outcomes and prevent the occurrence of tobacco-related conditions. This review updates the aforementioned guidelines as a practical guide to cover the nuts and bolts of perioperative smoking cessation. Its goal is to assist surgeons, anesthesiologists, and other medical professionals and to increase patients' awareness of smoking risks before elective surgery.

Oral lichen planus and the Thr102Cys polymorphism of HTR2A: a pilot case-control study

Oral cancer is one of the most common types of cancer in the world, leading to over 177 000 deaths worldwide annually. The literature suggests that oral cancer might be preceded by potentially malignant oral lesions, such as oral lichen planus, a multifactorial chronic inflammatory condition with an autoimmune component. Smoking and alcohol consumption are two of the many triggers of oral lichen planus and oral cancer. Both habits have likewise been associated with the Thr102Cys polymorphisms in the HTR2A gene, which codes the 5-hydroxytryptamine receptor 2A (5-HT-2A). The aim of this study was to investigate the Thr102Cys polymorphism rs6313 (NG_013011.1:g.6230C>T on GenBank) in the HTR2A gene in patients with oral lichen planus, and to explore its association with smoking and alcohol consumption. This case-control study took place in 2009-16 in the Centre of Diagnosis of Oral Diseases of the Federal University of Pelotas, Brazil, a national reference centre in histopathological diagnosis. Women aged 18 years or older with a histopathological diagnosis of oral lichen planus and healthy controls aged 18 years or older were included. Each group included patients with and without smoking or alcohol consumption habits. Men and patients with other conditions were excluded. Cell samples from oral lesions were collected with cytological brushes (QIAamp DNA FFPE Tissue Kit, Qiagen, Hilden, Germany) for DNA extraction, and the Thr102Cys polymorphism was genotyped using 40x Human Custom TaqMan Genotyping Assay primers and probes (Life Technologies, Foster City, CA, USA). The study was approved by the Research Ethics Committee of the Federal University of Pelotas (reference 058/2008) and written consent was obtained from all participants. Statistical analyses were done with the Statistical Package for Social Sciences version 16.0. Categorical variables were analysed with the Chi-square test. Logistic regression analysis was presented by odds ratios (OR) and 95% CIs to evaluate the risk of Thr102Cys single nucleotide polymorphism in patients with oral lichen planus. 108 individuals were included (46 cases and 62 controls). Median age was 58 years (IQR 51-68). Significant differences were noted between patients in the control and oral lichen planus groups: smoking habits (p<0·0001), alcohol consumption (p=0·035), and presence of the Thr allele (p=0·021) were all higher in the control group. The adjusted logistic regression analysis showed that smokers had a reduced risk (OR 0·18 [95% CI 0·05-0·60]; p=0·005) of developing oral lichen planus compared with non-smokers. Moreover, individuals carrying the Thr allele in the Thr102Cys polymorphism also had a reduced risk (0·19 [0·05-0·67]; p=0·010) of developing oral lichen planus. Our results show that oral lichen planus is associated with the presence or absence of the Thr102Cys polymorphism and smoking habits. Although tobacco is a known carcinogen, the presence of the Thr allele in smokers might offer a protective effect to oral lichen planus development. Serotonin induces signalling cascades and platelet aggregation via 5-HT-2A, so even slight mutations might modify the receptor's function. Also, studies suggest that tobacco could alter and suppress immunological mechanisms. Considering the sample median age and that aging also affects immunity function, it is possible that mutations on 5-HT-2A receptors along with the tobacco immunosuppression might be beneficial in preventing immune-mediated disorders such as oral lichen planus. Nevertheless, it is noteworthy that the adverse effects of smoking far outweigh any benefits shown by this association. None.

Germline BRCA variants, lifestyle and ovarian cancer survival

ObjectiveWomen with ovarian cancer who have a pathogenic germline variant in BRCA1 or BRCA2 (BRCA) have been shown to have better 5-year survival after diagnosis than women who are BRCA-wildtype (non-carriers). Modifiable lifestyle factors, including smoking, physical activity and body mass index (BMI) have previously been associated with ovarian cancer survival; however, it is unknown whether these associations differ by germline BRCA status. MethodsWe investigated measures of lifestyle prior to diagnosis in two cohorts of Australian women with invasive epithelial ovarian cancer, using Cox proportional hazards regression to calculate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). ResultsIn the combined studies (n = 1923), there was little association between physical activity, BMI or alcohol intake and survival, and no difference by BRCA status. However, the association between current smoking status before diagnosis and poorer survival was stronger for BRCA variant carriers (HR 1.98; 95% CI 1.20–3.27) than non-carriers (HR 1.18; 95% CI 0.96–1.46; p-interaction 0.02). We saw a similar differential association with smoking when we pooled results from two additional cohorts from the USA and UK (n = 2120). Combining the results from all four studies gave a pooled-HR of 1.94 (95% CI 1.28–2.94) for current smoking among BRCA variant carriers compared to 1.08 (0.90–1.29) for non-carriers. ConclusionsOur results suggest that the adverse effect of smoking on survival may be stronger for women with a BRCA variant than those without. Thus, while smoking cessation may improve outcomes for all women with ovarian cancer, it might provide a greater benefit for BRCA variant carriers.